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Factors related to fear in patients undergoing cataract surgery: A qualitative study focusing on factors associated with fear and reassurance among patients who need to undergo cataract surgery

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Abstract

The aim was to identify factors that are related to fear among patients who need to undergo cataract surgery. The data were collected by focus group interviews (n=27). The doctor-patient relationship, patient education, the wait, hospital organization, social support, sensations, previous experience, outcome of surgery, and coping strategies were identified as the main factors that contribute to feelings of fear related to cataract surgery. Five stages of fear were identified: at home after diagnosis, during preparation for surgery at the hospital, the day of surgery, the post-operative visits, and the period after these follow-up visits at home. A model regarding the factors related to fear in patients awaiting cataract surgery was developed, which emphasizes the importance of a good doctor-patient relationship, and the need for patient education that is tailored to the individual patients.

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... Fear and anxiety are the dominant and most frequently reported negative feelings related to cataract surgery. [5][6][7][8][9][10][11][12][13] However, it is difficult to estimate the number of patients who experience them. Data vary depending on the study group, ophthalmic center, and phase of the entire procedure analyses were carried out. ...
... These include the relationship between the patient and the doctor, the scope of the patient's preoperative education about cataract and its treatment, previous experience, waiting period before the surgery, work organisation in the hospital in which the operation takes place, social support, the patient's general emotional state, and coping with stress. 12 The emotional state of a patient depends on many unpredictable circumstances and varies from stage to stage throughout the cataract treatment process. ...
... This rebound in emotions results from the fear of surgical outcomes. 12 Below is an analysis of the individual stages of the routine cataract surgery procedure, taking into account the causes of fear and anxiety typically occurring during these periods. ...
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Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.
... 2,7 Previous surgical experiences, not necessarily related to ophthalmic procedures, may also increase or decrease patient preoperative fear. 8 Fostering an appropriate doctorpatient relationship, ensuring social support, and providing sufficient knowledge about the patient's condition and treatment (eg, mentioning the safety of cataract surgery itself) can significantly reduce anxiety in patients. [7][8][9] Only a few studies have compared patients' preoperative feelings based on whether surgery was being performed in the first or the second eye. ...
... 8 Fostering an appropriate doctorpatient relationship, ensuring social support, and providing sufficient knowledge about the patient's condition and treatment (eg, mentioning the safety of cataract surgery itself) can significantly reduce anxiety in patients. [7][8][9] Only a few studies have compared patients' preoperative feelings based on whether surgery was being performed in the first or the second eye. These studies have suggested that patients undergoing their second-cataract surgery tend to experience less anxiety and greater pain than those undergoing their first-cataract surgery. ...
... Most previous studies only assessed anxiety and fear during the preoperative period, often utilizing other diagnostic tools, including electrocardiograms or Holter monitors. 8,9 In contrast, our data provided a very accurate and detailed analysis of patient feelings throughout the preoperative period. Our approach allowed for the identification of the exact elements and procedures that were burdensome and unpleasant for patients, as well as the areas needing improvement. ...
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Purpose To compare the subjective preoperative experiences of patients undergoing their first- or second-cataract surgeries. Patients and Methods Consecutive patients undergoing phacoemulsification were asked to complete postoperative questionnaires evaluating their subjective preoperative experiences, including their emotional state, decision-making process, and opinions on the admission and examination processes, medical interviews, and quality of service. The obtained data were compared between patients undergoing their first (group I)- or second (group II)-cataract surgeries. Results Two hundred patients (group I, 124; group II, 76) were included in the evaluation. Presurgical anxiety was more prevalent in group I than in group II (55.7% vs 34.2%, P = 0.005). Fear was the major trigger for reconsidering the decision to undergo surgery, with 29% and 13.2% of patients in groups I and II, respectively, considering abandoning the operation (P = 0.016). The preoperative medical examination was reported to be sufficiently accurate by 66.1% and 80.3% of patients in groups I and II, respectively (P = 0.047), while 28.2% and 21% of patients in groups I and II, respectively, did not understand the information presented about possible complications of surgery (P = 0.039). Administration of eyedrops before surgery was uncomfortable for 71.4% and 68.4% of patients in groups I and II, respectively (P = 0.553), while 22.6% and 9.2% of patients in groups I and II, respectively, found repeated administration of drops to be highly uncomfortable (P = 0.026). Conclusion Patients experienced greater anxiety before their first-cataract surgery than before their second-cataract surgery. Moreover, many patients from both groups did not understand the medical information provided by doctors regarding the surgery and its possible complications. The most unpleasant stage of preparation for cataract surgery was repeated administration of eyedrops. Trial Registration The study was registered on clinicaltrial.gov under the number NCT04327856.
... The moment of receiving surgery news can then be experienced in different ways. (4) With scientific advances, the continuing improvement of surgical techniques have made cataract surgery an outpatient procedure with local anesthesia and a growing safer and more efficient procedure. (5) Phacoemulsification is an efficient procedure in Brazil with regard to its impact on the public health care system. ...
... (6) However, despite the subsequent success to the improvement of surgical techniques, patients tend to have high levels of fear and anxiety in the preoperative period. (4,7,8) During cataract surgery, patients are awake and need to collaborate with the surgeon, keeping silent, motionless, keeping the eye in the same position. If their emotional reactions are not considered, there may not be cooperative with possible injury to surgery. ...
... The requirement of having indication for cataract surgery by itself is cited in several studies as a important cause of fear. (4,(15)(16)(17) A study performed in Campinas (Brazil) and Chimbote (Peru) noted that 30.0% of individuals diagnosed with cataract refused surgery because of fear. (18) When analyzing the main causes of fear, it was observed that among the sensations of blindeness, worsening of vision, surgery complications, fear of anesthesia, pain, religious principles, there was no statistically significant difference between groups, suggesting that even individuals with binocular vision are afraid of losing or getting worse. ...
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Purpose: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). Methods: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. Results: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 ± 10.4 years) and 110 in Group 2 (68.2 ± 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. Conclusion: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery. Ouvir.
... Anxiety is the most common negative affect associated with surgery as well as a reliable predictor of postoperative mood and pain sensation [1,2]. Former studies confirmed that cataract surgery patients often experience fear and anxiety [3][4][5] not only during but also before and after the operation, and during postoperative visits [6,7]. The consequences of high perioparative anxiety range from increased pain sensitivity [2], blood pressure and heart rate [8], medication requirement [9], and reduced compliance during the procedure [10]. ...
... So far no studies evaluated the effectiveness of a combination of preoperative information and positive suggestions in cataract surgery. Furthermore former studies usually looked at a small number of measurement points thus only providing information on a subset of the previously identified stages of perioperative distress [7]. ...
... As such, the intervention should be subjected to further, more focused investigation. According to Nijkamp et al. [7], the anxiety of the patients does not stop at the end of surgery, rather it carries on through the postoperative visit and beyond that. Our results imply that the relapse of anxiety at the time of the post-operative visit might be alleviated using a preoperative intervention. ...
... 9,10 Fear, which may be caused by fear of pain and/or complications of surgery, has been associated with anxiety-induced complications, such as uncontrolled hypertension and a higher rate of dissatisfaction. 11,12 Appropriate preoperative education can mitigate fear. [11][12][13] In this age of readily available information and more informed patients, the physician's input is competing with input from a variety of sources. ...
... 11,12 Appropriate preoperative education can mitigate fear. [11][12][13] In this age of readily available information and more informed patients, the physician's input is competing with input from a variety of sources. Patients may be acquiring more knowledge from relatives and friends (77%) as opposed to their physician (40%). ...
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Objective This study utilized a phone survey to characterize patient perceptions of cataract surgery and the manner in which the ophthalmologist contributes to the patient’s understanding in electing cataract surgery. Patients and methods Calls were made from a randomized membership list of the American Association of Retired Persons until 1,000 respondents 50 years of age or older had been recruited. Three groups were recruited: persons with no prior diagnosis of cataracts, persons diagnosed with cataracts but who had not had surgery, and persons who had had cataract surgery on both eyes within the past 5 years. A series of fixed-choice and open-ended questions was then presented to qualified participants. Questions related to vision, quality of life, and the understanding and perceptions of cataract surgery. Results Two-thirds of respondents reported having frequent eye examinations. More than half indicated that they had discussed cataract surgery with an eye doctor, most often with an ophthalmologist. They reported that the benefits of surgery were most often mentioned (68%), but lens options were infrequently mentioned (39%). Of those who had had surgery, 81% elected to do so on the advice of their health care professional. About 85% of respondents who had had surgery felt well educated about the procedure, though only 75% felt they understood their lens and vision options. Three-quarters of those who had had cataract surgery wished they had had the surgery sooner, and reported that they were enjoying life more after surgery. Conclusion The ophthalmologist plays an important role in preparing patients for cataract surgery. Discussing both the timing of the surgery and the patient’s lens options are critical for appropriate care; the survey results suggest room for improvement in this regard. Respondents reported they wished they had had surgery sooner, based primarily on their improved quality of life postoperatively.
... Anxiety in patients could be induced by unfamiliar situations, physical separation from family, no or little knowledge about medical interventions, diagnosis, or therapeutic methods, and high costs of operation, hospitalization, anesthesia induction, post-operative pain, possible future disabilities, and death (3). The prevalence of anxiety in highly-selective patients prepared for elective operations has been reported as high as 80% (4,5). ...
... Anxiety during surgery might influence the desired outcomes of surgical treatment and after surgery affect the predicted clinical improvement and mental health. Moreover, I anxiety causes hypertension, increased heart rate, and it might lead to bleeding and other probable post-operation side effects (5). On the other hand, long-term anxiety increases metabolism, oxygen consumption, and emotional conception of pain. ...
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Objective: The goal of this study was to evaluate preoperative anxiety and its predisposing factors in a group of adult patients who were candidate for any kind of heart surgery. Methods: We evaluated preoperative anxiety in 300 patients undergoing heart surgery whose ages ranged between 18-65 years. Relationship of probable demographic factors like gender, educational level, marital status, number of children, family support, opium addiction, occupational status, and left ventricular ejection fraction (LVEF) with anxiety level of the patients were evaluated. To determine anxiety, the State-Trait Anxiety Inventory (STAI) was completed by the subjects. Results: Descriptive anxiety levels showed that mean of state and trait anxiety of our studied patients were in moderate scaling. Correlation between state and trait anxiety was more prominent in females (r = 0.80) than in males (r = 0.70) (p < 0.001). Distribution of males and females was significantly different (p = 0.048). All the patients had significantly different underlying diseases (p = 0.018), opioid addiction (yes/no) was significantly different in all of the patients (p < 0.001), while family support (yes/no) was not significantly different in all of the patients (p = 0.453). There were significant differences between mean of preoperative anxiety at different LVEF values of any EF level (p < 0.001, F = 6.47); those who had LVEF of more than 50% had significantly lower mean anxiety scores. Conclusion: Preoperative psychiatric consultation should be focused more on women and patients with higher EF. Moreover, physical activity strength may be effective on reducing preoperative anxiety.
... 최미정 · 박정숙 체를 삽입하는 수술이 많이 시행되고 있다 (Hardy, 2009 (Cho & Rho, 2012), 수술과정 동안 환자는 누워서 움직이지 않고 눈을 고정시키는 등 의사의 지시를 따라야 한 다 (Morrell, 2001). 백내장은 심각한 동반질환이 없으면 수술 을 통해 성공적으로 치유될 수 있는 비교적 간단한 수술이나, 환자들은 수술로 인한 실명 가능성에 대한 공포감 및 불안감을 나타내고 (Nijkamp et al., 2002), 의식이 있는 상태에서 수술 이 진행되므로 절차 자체의 공포와 수술 중 경험하게 될 통증 및 감각에 대한 걱정으로 인해 불안을 느낄 수 있다 (Foggitt, 2001). 불안은 치유과정을 방해하는 생리적 반응을 일으키며 (Grieve, 2002), 교감신경계를 활성화해 혈압과 맥박수가 증 가한다 (Yasunari et al., 2006 (Mitchell, 2002). ...
... ). 수술한 다음날부터 구부리기, 요리, 청소, 걷기나 중등 도의 운동, TV시청 등의 일상생활이 가능하나 합병증에 대한 두려움으로 불필요하게 일상생활을 제한하고 수술 후 자가간 호 방법에 대한 정보가 부족하여 치료지시를 불이행하는 문 제가 생기기도 한다(Fayers, Abdullah, Walton, & Wilkins, 2009). 그러므로 백내장 수술 후 자가간호에 대한 정확한 지식 을 제공하는 교육이 필요하다(Nijkamp et al., 2002). 전반적인 수술 환자의 불안감소와 자가간호 수행 증진을 위한 간호중재로 정보제공과 교육에 대한 많은 연구들이 진 행되어 왔으나, 백내장 수술 환자를 대상으로 교육중재를 제 공한 연구는 그리 많지 않았다. ...
Article
Purpose: The purpose of this study was to investigate the effects of a structured preoperative instruction upon anxiety and postoperative self-care compliance. Methods: A randomized control group pre-post design was used. Sixty subjects undergoing cataract surgery were randomly assigned to one of two groups. The instruction consisted of cataract surgery procedure, sensory information, deep breathing, use of eye drop, and post op self-care regimen and was provided to the experimental group with control group receiving an usual treatment. State anxiety NRS, pulse, BP, and self-care compliance scale developed by Cho & Rho were used. Data were collected at two time periods: on the day of surgery in the clinic and prior to anesthesia in the operating room. The postoperative self-care compliance scores were measured at their second visits to the hospital after surgery. Data were analyzed using Kolmogorov Smirnov test, t-test, and Mann-Whitney U test. Results: There were significant differences between the two groups in the postoperative state anxiety (t=-3.57, p=.001) and the postoperative self-care compliance score (t=3.92, p
... 9,10 The fear of surgery and uncertainty of surgical outcome are the most common uptake barriers. 11 Apart from these genuine fears, the situation in Africa is made worse by ignorance of the processes involved in ophthalmic surgery. For instance, there is a believe that an ophthalmic surgeon brings out the eyeball from the eye socket before operating on it. ...
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OBJECTIVE: To evaluate the perception of ophthalmic surgeries among ophthalmic outpatients of Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu. METHODS: A hospital based cross-sectional descriptive study. Eligibility criteria included consented adults aged 18 years or above, who attended the eye clinic within the period of study irrespective of patient's ocular pathology. The study instrument used was a pretested, researcher-administered structured questionnaire containing Participant's demographics and their perceptions of eye surgeries. Data was analyzed using Statistical Package for Social Science (SPSS), version 20.0. Chi-square(x 2) was used for class comparisons while student T-test was used to compare means. A P<0.05 was considered statistically significant. RESULTS: There were 125 participants comprising of 54 (43.2%) males and 71(56.8%) females (M:F =1:1.3) with a mean age of 50.58 + 16.13 SD years. The participants were mainly married 88 (70.4%), 51 (40.8%) civil servants and 61 (48.8%) had tertiary education. All the participants were aware that surgery was a treatment option for some eye diseases, cataract surgery predominating (101, 80.8%). Hospital was the most common source of information among the subjects (63, 50.4%) and religious institutions the least (2, 1.6%). Eighty eight percent (88%) of the subjects believed that surgery can improve vision but 30.4% affirmed that they will never want to have any eye surgery. Being female (p=0.012) and having tertiary education (p=0.011) were significant variables for refusal. CONCLUSION: This study strengthens the argument for improved communication with our patients in the strive to increase surgical uptake. But it has also revived the need to further interrogate the roles of the female gender and the unlikely duo of higher education and religious exposure in the resistance to eye surgical interventions.
... During the surgery, patients doesn't feel as painful as they expect so they feel that the first eye surgery is not particularly painful and have high satisfaction. When the second eye ICL surgery is performed, the patients are already familiar with the surgical procedure, the level of anxiety and tension has decreased [32], and the patients anticipate a relaxing and painless surgical experience. If the intraoperative experience was found to be inconsistent with their expectations, they experienced more pain and had less satisfaction [9,31,33] . ...
Article
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Purpose The purpose of this study was to compare the preoperative anxiety, aqueous humor monocyte chemoattractant protein-1 (MCP-1) concentration, intraoperative pain, and degree of cooperation of the first eye implantable collamer lens (ICL) surgery with the second eye surgery, of the 1-day interval group with the 1-week interval group, and to investigate the possible causes of these differences, as well as to determine the appropriate interval between bilateral eye ICL surgeries. Method The study was a prospective observational study. A total of 120 patients who underwent bilateral ICL surgery at the Department of Ophthalmology, West China Fourth Hospital, Sichuan University, from July to September 2023, were enrolled. The patients were divided into a 1-day interval group and a 1-week interval group. The ICL surgery was performed on both eyes according to the schedule. Anxiety levels, aqueous humor MCP1, cooperativeness, surgical time, pain and satisfaction, and patients’ estimations of the time spent in the operation were recorded for each eye. The patients were instructed to recall the intraoperative pain of the first eye surgery after the operation of the second eye. Statistical analyses (two independent samples t-test,two paired samples t-test, the rank-sum test, the chi-square test, non-parametric test with multiple independent samples) were performed to compare the differences between each score in both eyes and two groups. Furthermore, we examined the relationship between pain levels and the reproductive history of the patients. Results In the 1-day interval group, male/female is 22/52, average age is 25.24±5.00. In the 1-week interval group, male/female is 17/29, average age is 25.39±5.57. There was no statistically significant difference between the two groups. In both groups, patients were less nervous, had significantly more pain, had less surgical satisfaction, had a longer estimated operative time, and had elevated preoperative MCP1 during the second eye operation. In the second eye surgery, the patient’s cooperation worsened, but it did not lead to an increase in surgical time. A significant proportion of patients, particularly in the 1-week interval group, recalled experiencing reduced pain during the first eye surgery. The 1-week interval group had a higher difference in all indicators between the bilateral surgeries. In the second eye surgery, patients in the 1-week interval group experienced more severe pain, less cooperation, longer estimated operation duration, and a greater MCP1 than those in the 1-day interval group. Conclusion Patients undergoing second eye ICL surgery had decreased nervousness, increased pain, decreased cooperation, and satisfaction, and increased MCP1 compared to the first eye surgery. It is recommended that an interval of about one week should be avoided between bilateral surgeries when developing a surgical schedule to improve patients’ cooperation, satisfaction, and comfort.
... Such strategies could be used to complement other methods that psychologically prepare patients for the surgery journey such as cognitive behavioural therapy, preoperative videos and patient education programs [16]. Effective patient communication is also important since a strong doctor-patient relationship and clear patient education about the disease and the surgery have been found to be important for reducing preoperative anxiety in cataract surgery patients [17,18]. Further, given that optimism has been found to help patients cope with the stress of only eye surgery, encouraging patients to be optimistic may be bene cial. 2 Supporting this notion, a review by Sweeney and Andrews [19] identi ed that optimism grounded in reality, has been found to improve patient outcomes. ...
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Background/Objectives “Only Eye Surgery” can be a stressful experience for both surgeons and patients. Our study aimed to quantitatively explore the patient experience of having eye surgery on their remaining seeing eye. Subjects/Methods A retrospective cohort study comparing monocular and binocular patients recruited from clinics in Brisbane, Australia. 107 patients (43 monocular, 64 binocular) completed a 12-item questionnaire regarding their experience. Results Multiple linear regression analysis identified that preoperative anxiety is greater in only eye surgery, (β=-13.99, 95%CI=-25.73 to -2.26, p < 0.05) and there were more worries about losing vision from surgery (β=-18.40, 95%CI=-32.31to -4.49, p < 0.05). The perceived level of support after surgery in binocular patients is influenced by their level of support from family or friends to discuss prior to surgery (r = 0.72), whereas in monocular patients, such level of support is influenced by patients’ level of trust in the surgeon (r = 0.50) and anaesthetist (r = 0.73). Conclusions Clinicians can provide support by acknowledging their patients’ anxieties related to loss of vision and its potential impact on lifestyle. By addressing these issues and providing the opportunity to discuss other aspects of the surgery preoperatively, further trust in the surgeon can be achieved. Postoperatively, the patient will feel more supported and enhance the recovery journey. In the advent of adverse outcome, the surgeon who has gained that higher level of trust, the patient will be more likely to feel reassured that everything was performed to the highest possible standard and more likely to accept the resulting level of vision.
... 12 Various studies state that cataract patients can experience anxiety preoperatively, intraoperatively, and postoperatively. [13][14][15] Anxiety has a number of complications such as pain, nausea, vomiting, cardiovascular disturbances such as tachycardia and hypertension, and increased risk of infection. Various studies show that a large proportion of surgical patients experience considerable preoperative anxiety, and this is reported to affect 60-80% of surgical patients. ...
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Background/purposes/objective To evaluate the impact of video and verbal counselling on patient's undergoing phacoemulsification under topical anaesthesia. Methods This is a prospective randomized controlled trial conducted at Aravind Eye Care System, Pondicherry, India. All patients had a 15 min one-on-one verbal counselling covering about surgical technique, implant options, anaesthesia and payment options one day prior to surgery. Following which on the day of surgery, patients were randomized into two groups; in the first group, patients were provided with video counselling and in the second group, patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia. Measurements of blood pressure, heart rate, respiration rate, and the Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points. Results A group of 186 patients (aged 45–70 years) were provided video counselling via a portable iPad before first-time phacoemulsification, and a second group of 186 patients underwent surgery with verbal counselling. Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point. During the intraoperative period, 123 (66.1%) video counselled patients felt relaxed compared to 119 (64%) patients who were provided verbal counselling (p = 0.6636). Patient cooperation during surgery was excellent in 76(40.9%) video counselled patients and 67(36%) verbally counselled patients (p = 0.3374). 25.8% and 21% (p = 0.2703) of patients experienced no pain during surgery in the video and verbal counselled groups respectively. Conclusions Although measures such as pulse rate, respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling, patients marked cooperation during surgery and level of anxiety is most reassuring.
... Intriguingly, these symptoms were more intense during the surgery in the second eye than that in the first eye, especially for pain perception, which had been noticed extensively (Tan et al., 2011;Ursea et al., 2011;Adatia et al., 2015;Jiang et al., 2015;Yu et al., 2016;Liu et al., 2020). Psychological factors like anxiety and perception during the first surgery would influence the patient's eye sensation (Nijkamp et al., 2002;Ang et al., 2007;Adatia et al., 2015) while physiological factors, such as repeated penetrating injuries, might have triggered a subclinical sympathetic inflammatory reaction in the fellow eye . ...
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Patients were found to experience more pain during their second eye cataract surgery compared with their first eye surgery. This study aimed to explore the inflammatory alterations along time in the fellow eye after the first eye surgery and to reveal the underlying mechanism. Eighty patients with bilateral cataracts were recruited and were divided into four groups based on the time of having the second eye surgery. The second eye aqueous humor samples were collected just before surgery and analyzed by mass spectrometry and PCR array. Cytokine activity was enriched in the aqueous humor of the contralateral eye with granulocyte colony-stimulating factor CSF3 significantly upregulated at both gene and protein levels. Rabbits with or without superior cervical ganglionectomy (SCGx) were subjected to lensectomy to mimic human situations. In both human and rabbit models, the fellow eye CSF3 peaked at 1 week post the first eye surgery. Consistently, more neutrophils were recruited to the contralateral eye aqueous humor. Corneal sensitivity and trigeminal electrophysiology were recorded to imply the pain severity in rats receiving capsulorrhexis with or without SCGx. A more intense pulse was detected in the contralateral trigeminal ganglion after the rat received one eye surgery. SCGx could effectively reduce the fellow corneal sensitivity and trigeminal nerve pain. These alterations were under direct regulation of the sympathetic nerves on the surgical eye side. Our results suggest that CSF3 and sympathetic activity could serve as potential analgesic targets during ocular surgeries.
... Patients undergoing cataract surgery tend to show negative emotions such as fear or anxiety . Some studies indicated that cataract patients can experience anxiety before surgery, during and in some period of time after surgery 1993, Foggitt 2001, Nijkamp et al. 2002. Information about medical procedures is one of the most important factors regarding patient satisfaction and the reduction of anxiety (Pager et al. 2004). ...
Article
Background: Fear is a negative emotion induced by the threat of danger, pain and harm. Cataract surgery is one of the most performed surgeries in the world. The aim of this study was to investigate and analyze the predominant fears in patients undergoing cataract surgery. Subjects and methods: In this cross-sectional study 152 patients were examined. Self-designed questionnaires to examine emotions of the fear, anxiety, nervousness frequency gratitude was used and insecurity immediately before cataract surgery. We also examined what the greatest fear during the cataract surgery was. The fear of blindness was compared with other life fears such as cancer, memory loss, AIDS, stroke and heart attack. The presence of fear was compared in patients having had previous cataract surgery with those undergoing their first cataract surgery. Including criteria were adults with senile cataract. Excluding criteria was ocular co-morbidity, psychiatric disorders, inability to read, deafness and surgery under general anesthesia. Completed questionnaires were analyzed. Pearson's chi-squared test was used. Results: Fear was the most frequent emotion before cataract surgery, present in 60.5% patients. Fear of blindness was the greatest fear during cataract surgery in 55.3% of patients. There was no statistically significant difference in fear in patients having undergone their first cataract surgery and patients before their second cataract surgery (p<0.05). Conclusion: Fear is the predominant emotion before cataract surgery which is in correlation to the leading life fear - fear of blindness. Good preoperative preparation and a trusting doctor-patient relationship are important for reducing the fear of the procedure.
... Physician-patient relationship plays a role in the awake procedures because on anxiety and distress for both patients and training doctors. 56,57 The key to the success of awake procedures is the preoperative selection of patients with an anxiety level that can be intraoperatively managed and an adequate patient's preparation during anesthesiologist counseling. a study suggested that a technical language used by surgical staff during the procedure can increase patients' anxiety level and pain. ...
... When we maximized the comparability by matching baseline and clinical characteristic such as preoperative anxiety between the two groups, similar results were also discovered, which inferred that some factors after the first surgery might affect patients' perceived pain during secondeye surgery. As we know, psychological factors such as anxiety might influence patient responses to surgery and the degree of perceived pain [29]. Prior studies have found that patients were more relaxed during their second-eye surgery, whereas decreased anxiety might result in increased awareness during the procedure, which might make the sensitivity to pain increased and have a negative influence on experience during the second-surgery [30,31]. ...
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Background The purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract. Methods Consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups. Results pain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries. Conclusions MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.
... 6,[20][21][22][23][24][25] Patients operated for cataract usually expect that the surgery will enable them to achieve spectacle independence and normalization of visual acuity. [26][27][28][29][30][31][32][33][34] Commonly, and most persons subjected to cataract surgeries are highly satisfied with the outcomes. 27,30,31,34,35 However, persons with higher preoperative expectations were shown to present with lower levels of postoperative satisfaction. ...
Article
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Purpose We analyzed the subjective feelings and opinions of patients regarding modified cataract phacoemulsification procedures. Patients and Methods A consecutive case series of patients undergoing phacoemulsification of cataracts, who completed questionnaires designed by the authors to evaluate their subjective opinions about hospital admission, medical examination, and intraoperative procedures carried out at the operating theater. Results Two hundred patients (82 men and 118 women) were included in the study. Subjects aged ≥65 years more often than younger respondents presented negative opinions about hospital admission procedures (15% vs. 2.5%, p=0.032) and were less satisfied with physicians’ explanations about the matter of phacoemulsification (71.3% vs. 92.5%, p=0.004), type of artificial lens to be implanted (43.8% vs. 85%, p<0.001), and potential complications (69.4% vs. 95%, p<0.001). The most unpleasant intraoperative experiences included venipuncture (35.5%), artificial lens implantation (30.5%), and peeling off of a sterile surgical drape (24%). Conclusion Persons aged ≥65 years presented with negative opinions about routine procedures related to phacoemulsification. Older age seems to be associated with less tolerance to time-consuming bureaucratic procedures and a lesser understanding of the specific stages of the surgery. Older patients should be notified in advance about all routine procedures to be carried out and provided with a rationale for these activities. Trial Registration The study was registered on clinicaltrials. gov (NCT04327856).
... Cataract, being most common cause of blindness and conventionally being treated by surgery, accounts for most of the ophthalmic operations (3). Literature reveals that patients can experience anxiety preoperatively, intra-operatively, postoperatively (2,(4)(5). The various reasons for anxiety could be fear of blindness, premorbid personality traits, and inadequate knowledge about surgery. ...
Article
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Being posted for cataract surgery can be source of anxiety for the patient. This study was conducted to assess the presence of anxiety symptoms and their correlations with various socio-demographic variables in patients posted for cataract surgery. It was a cross-sectional, non-randomized, single interview study. 50 consecutive patients posted for cataract surgery were included. Each patient was individually interviewed using a semi-structured proforma prepared for the study which included socio-demographic profile, clinical and psychiatric profile and ophthalmological diagnosis. To assess various domains of anxiety, Hamilton Anxiety Rating Scale (HAM-A) was administered. About 80% of patients reported at least 2 or more anxiety symptoms but most of these symptoms were transient in nature. 92% had anxiety scores less than or equal to 13 on HAM-A. Only 14% patients reported worries on MSE. We did not found a diagnosable anxiety disorder in patients posted for cataract study. Only 8% of subjects had mild to moderate scores on Hamilton anxiety rating scale. Also the patients with mature cataract have statistically significant correlation with HAM-A scores.
... In Hungary, the health care system is financed by the state; thus, the entire cataract surgery procedure is performed at no cost to the patient (the health insurance supports the transportation and the medication also, and therefore, the cost of the surgery was not mentioned as a reason to not undergo surgery by the participants. Our quantitative survey is too limited to develop any further conclusions, qualitative studies needed for deep analysis of barriers to cataract surgery [29] . limitations Our participation rate was high, but Ramke et al [30] suggested that even high participation rates do not completely nullify response bias. ...
Article
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Aim: To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged ≥50y in Hungary, and to assess the cataract surgical services. Methods: A rapid assessment of avoidable blindness (RAAB) was conducted. A total of 3523 eligible people were randomly selected and examined. Each participant underwent surgery for cataract was interviewed with regard to the year, place, and costs of the surgery. Participants with obvious cataract were asked why they had not yet undergone surgery (barriers to surgery). Results: An estimated 12 514 people were bilaterally blind; the visual acuity (VA) in 19 293 people was <6/60, and the VA in 73 962 people was <6/18 in the better eye due to cataract. An estimated 77 933 eyes are blind; 98 067 eyes had a VA of <6/60, and an estimated 277 493 eyes had a VA of <6/18 due to cataract. Almost all cataract surgeries were conducted in government hospitals. The age- and sex-adjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%. The rate of good visual outcome after surgery was 79.5%. Ocular comorbidity was the main cause of poor outcome (78.1%), followed by late complications (such as posterior capsule opacification) (17.2%), inadequate optical correction (3.1%), and surgical complications (1.6%). The main barrier to surgery in people with bilateral cataract and VA of <6/60 was 'need not felt'. Conclusion: The prevalence of visual impairment resulting from cataract is slightly higher than expected. The quality of the cataract surgical service seems adequate in Hungary. However, the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population.
... Participants specifically appreciated that Mercy Ships staff explained everything they were doing; supporting research suggests patients who understand what is happening during a medical procedure feel much less fearful throughout the process. 30 Ultimately, patient trust of local providers must be increased; through patient advocacy, so patients feel less fearful about surgery, and through provider training in trustbuilding behaviours. Missions and local surgical teams must work together to increase patient trust and improve patient experiences. ...
Article
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Objectives This study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms. Setting Data were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard the Africa Mercy, a non-governmental hospital ship. Participants Sixteen patients (seven male, nine female, age range 22–71, mean age 43.25) who had previously received surgical care aboard the Africa Mercy hospital ship between September 2016 and May 2017 participated in the study. Methods Using a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach. Findings Analysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams. Conclusions While foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.
... Educating patients has been proven to be useful, 28 as it may reduce patients' anxiety and, as a consequence, their need for periodic follow-up. 29,30 A recent review on BCC care emphasizes the importance of counselling patients about self-screening. 31 Providing more, and preferably written, information to patients therefore seems a useful and feasible strategy to de-adopt low-value follow-up care. ...
Article
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Basal cell carcinoma (BCC) is the most common type of cancer worldwide and its incidence is still rising. It is a type of skin cancer, but it is generally slow‐growing and very rarely spreads elsewhere in the body. Currently, guidelines recommend to only provide follow‐up care (e.g. annual check‐ups) to BCC patients considered ‘high risk’ according to certain factors, such as the size of the tumour, its location, and if it was faster growing than normal. However, dermatologists still provide follow‐up care to patients with low‐risk BCCs as well. To understand why this so called ‘low‐value care’ is provided and to identify strategies to reduce this care, the Dutch authors (based in Rotterdam) interviewed 18 dermatologists and organised three focus groups with 17 low‐risk BCC patients. The interviews and focus groups were audio taped and then transcribed literally. These transcripts were then loaded into a software programme and analysed for themes. Two main reasons given by dermatologists for providing low‐value follow‐up care were: i) complying with patient preferences and ii) a lack of trust in general practitioners (GPs) to identify suspicious lesions (possible skin cancers). Financial incentives and force of habit were two further reasons. Patients also expressed a lack of trust in GPs, and whereas some of the BCC patients preferred receiving periodic follow‐up care, other patients felt it was unnecessary. Several strategies for reducing follow‐up care were suggested, of which educating patients was identified as potentially effective by dermatologists and patients. Results of this study have already been incorporated in a pilot study, in which BCC patients receive written information which includes information about their disease, treatment, recurrence chance and chance of subsequent BCC. This letter is tailored to their specific situation.
... Whilst these current findings support that notion (poor surgical outcome increases fear levels thus maintaining a barrier in accessing cataract surgery), it is not the only factor that causes fear to act as a barrier. The more knowledgeable a patient is about the operation, the less they fear it (Chaudry et al., 2014;Nijkamp et al., 2004Nijkamp et al., , 2002. Knowledge of the cataract surgery plays a very important role that spans all the operative stages. ...
Article
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Purpose To explore the fear of cataract surgery experienced by the residents of the Kwale district of southern Kenya. Methods The Kwale Eye Centre (KEC) is the only stationary specialist hospital in the Kwale County of southern Kenya. Patients attending the Centre as a walk-in clients during the data collection period were screened and recruited to the study. Fully informed consent was obtained. Qualitative semi-structured interviews (SSI’s) were used for data collection. Each interview followed a question guide and was recorded in a digital-audio format. The interviews were transcribed verbatim and thematic analysis performed on the consequent transcripts. Results A total of 20 SSI’s were performed. Most preoperative fears are directly linked to or provoked by “rumours” that surround cataract surgery. 65% of participants identified fear originating from narratives passed on to them by friends and family. These rumours ranged from inaccurate reporting of the process of cataract surgery to completely unfounded information. The most common intraoperative fear of cataract surgery was concern over the injection. A frequently noted postoperative fear was that of suffering further eye damage. Conclusion The long standing service the KEC has provided might have decreased the fear surrounding cataract surgery as a consequence of increased awareness. Yet, even when accurate information is provided, rumours continue to spread. Knowledge of the cataract surgery plays an incredibly important role in decreasing fear across all the operative stages. This study shows a great deal of fear is not rational and may perhaps be significantly lessened if addressed.
... Educating patients has been proven to be useful, 28 as it may reduce patients' anxiety, and, as a consequence, their need for periodic follow-up. 29,30 A recent review on BCC care emphasises the importance of counselling patients about self-screening. 31 Providing more, and preferably written, information to patients therefore seems a useful and feasible strategy to de- adopt low-value follow-up care. ...
Article
Full-text available
基底细胞癌 (BCC) 和鳞状细胞癌 (SCC) 是两种最常见的皮肤癌亚型。在 2013 年全世界有大约 550 万人至少发生这些癌症中的一种,且这一数字仍在上升。为了明确这些患者对于他们医疗保健的需求和喜好,作者们(来自荷兰 Erasmus MC 的皮肤科)邀请皮肤癌患者进行了小组访谈。共有 42 名 BCC 或 SCC 患者参与,他们被分为 6 个组来分享他们的想法和观点。这些焦点小组全部接受录音,并进行逐字转抄。接下来,将这些文件传入软件程序‘Atlas.ti’内。2 名作者为这些文本分配代码,以捕获其含义。之后将这些代码聚合成处理相同主题的代码组。最后,作者可以确定哪些主要主题对患者而言最为重要。BCC 和 SCC 患者对医疗保健的需求和喜好的相似性令人惊讶的高。两个患者组均表示,他们需要 (1) 收到所有的相关量身定制的信息(2) 一名能认真对待患者并能良好沟通的医生 (3) 等待期短且有直接结果的最佳治疗 (4) 接受来自同一医生的治疗 (5)治疗、(6) 随访和 (7) 结构式随访治疗期间,(8) 包括全身皮肤检查,对皮肤科医生的偏好。此外,BCC 患者表达了对于开放和透明以及参与他们医疗保健相关决策的需求。通过了解患者现在想要什么,可以将他们的视角添加到现行指南中,并将患者置于治疗的中心。 Linked Article: van Egmond et al. Br J Dermatol 2019; 180:122–129
... Educating patients has been proven to be useful, 28 as it may reduce patients' anxiety and, as a consequence, their need for periodic follow-up. 29,30 A recent review on BCC care emphasizes the importance of counselling patients about self-screening. 31 Providing more, and preferably written, information to patients therefore seems a useful and feasible strategy to de-adopt low-value follow-up care. ...
Article
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Background Providing follow‐up to low‐risk basal cell carcinoma (BCC) patients can be considered as low‐value care. However, dermatologists still provide substantial follow‐up care to this patient group, for reasons not well understood. Objectives The aim of this study was to identify factors influencing current BCC follow‐up practices among dermatologists and suggested strategies to de‐adopt this low‐value care. In addition, views of patients regarding follow‐up care were explored. Methods A qualitative study was conducted consisting of 18 semi‐structured interviews with dermatologists and three focus groups with a total of 17 low‐risk BCC‐patients who had received dermatological care. The interviews focused on current follow‐up practices, influencing factors, and suggested strategies to de‐adopt the follow‐up care. The focus groups comprised preferred follow‐up schedules and providers as well as content of follow‐up. All (group)interviews were transcribed verbatim, and analysed by two researchers using Atlas.ti software. Results Factors influencing current follow‐up care practices among dermatologists included complying with patients’ preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow‐up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de‐adopt the low‐value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realising appropriate financial reimbursement and informing dermatologists about the low‐value of care. Conclusions A mixture of factors appear to contribute to current follow‐up practices after low‐risk BCC. In order to de‐adopt this low‐value care, strategies should be aimed at dermatologists, GPs as well as patients. This article is protected by copyright. All rights reserved.
... Cataracts are lens opacities which result in a decrease in visual acuity and disruption in doing work, which causes a significant decrease in quality of life [1][2][3] . Senile cataracts (age related) occur as a result of the irreversible lens protein denaturation 4,5 . ...
Article
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Research on Patient Centered Care (PCC) in cataract patients is still limited, especially those that analyze the effectiveness of PCC in reducing anxiety levels and improving the patient satisfaction. This study was a quasi-experimental pre- and post-test design, which involved 30 treatment respondents and 30 control respondents. The instrument used a SAI questionnaire to measure anxiety and SERVQUAL modifications to measure patient satisfaction. The study was conducted at Nganjuk Eye Clinic in October-November 2018. Analysis of data using paired t-test and independent t-test. The results of different tests of anxiety levels before and after PCC and difference tests of anxiety levels of the control and PCC group showed the results of sig. 2-tailed = 0,000. Whereas the different tests of satisfaction levels between the control and PCC group were obtained sig. 2-tailed = 0.035. The PCC Effect Size obtained strong effects (2.59 and 4.31) in reducing anxiety and average effect (0.56) on improving satisfaction. There were significant differences in the level of anxiety and satisfaction in both groups. The results showed that PCC was very effective in reducing anxiety levels and quite effective in improving the satisfaction of cataract surgery patients.
... [4,5] The other studies also reported that patients experienced anxiety and fear throughout the whole operation process. [6,7] Moreover, such condition also results in more adverse events, such as high blood pressure and heart rate. [8,9] Several interventions are reported to reduce perioperative distress and to overcome its adverse effects from patients with PC. [10][11][12][13] However, these treatments still have limited effectiveness for the treatment of patients with PC. ...
Article
Full-text available
This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.
... 7 In terms of physician-patient interaction, the importance of operators instilling patients with a sense of trust via reassuring comments during surgery has been highlighted. 8 It has also been noted that good communication and information could lead to better patient confidence and satisfaction, less anxiety and pain, all linked with improved operative outcomes. 9 Significantly, Caddick et al 2 reported that careful use of terminology could serve to reduce anxiety levels, while Rufai et al 5 concluded that patients feel significantly less anxious when certain approaches are adopted by surgeons and theatre staff, with particular emphasis on verbal reassurance. ...
Article
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Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored. Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews. Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient. Conclusions Our findings indicate underlying patient assumptions about physicians’ experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.
... 4 Others have found similar findings before colonoscopy, local skin excisions, and dental procedures. [5][6][7] Previous ophthalmologic studies have identified anxietyinducing elements specific to cataract surgery, [8][9][10][11] reporting visual sensations and blindness among the major preoperative fears. However, there are few quantitative investigations examining the precise cause of unease in this population. ...
Article
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Purpose Reducing surgery-related patient anxiety without under-emphasizing surgical risk is challenging for even the most experienced surgeon. The purpose of this study is to identify specific anxieties faced by patients in hopes of better informing the preoperative surgeon-patient dialogue. Setting Comprehensive and specialty ophthalmology clinics at the University of California, San Francisco. Design A prospective, survey-based study in which a pre- and postoperative questionnaire was administered to patients undergoing routine phacoemulsification. The surgeon was masked to patient enrollment and questionnaire responses. Materials and methods A 36-item questionnaire on patient anxiety was developed from existing literature, building on the validated Surgical Fear Questionnaire. Patients were eligible if they were aged >18 years and willing to participate. Patients were excluded if having more than phacoemulsification alone or if unable to respond in English, and were retroactively excluded if there were complications during surgery. The primary outcome was self-reported anxiety on an 11-point Likert scale. Results Sixty-one patients were included for analysis. Preoperatively, patients reported greatest anxiety around the operation itself and becoming blind. Reflecting postoperatively, patients reported the greatest anxiety for the operation itself. Statistically significant decreases were greatest for anxiety about the operation failing (p<0.001) and becoming blind (p<0.001). No decrease was observed for the operation itself (p=0.1). Conclusion More effort must be made to specifically discuss the steps of the operation itself and the expected visual outcomes to alleviate patient anxiety. The authors hope these data can provide insight for surgeons into patient anxiety surrounding cataract surgery and help strengthen the patient–physician relationship.
... Patients' emotional conditions (e.g. fear, anxiety [9]) can affect their decisions about surgery. Those who choose not to undergo surgery let their cataracts remain untreated. ...
Article
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Senile cataract is a common cause of visual impairment among the elderly, yet its causes are still being investigated. Severe cataracts can progressively impair visual acuity and color discrimination in most afflicted patients. However, not all patients opt for surgery; instead, some use glasses as a temporary treatment. We conducted semi-structured interviews with 39 senile cataract patients regarding both their visual acuity and color discrimination after using corrective lenses. In this study, 19 (48.7%) patients described poor visual acuity or discomfort in either eye, while 16 (41.0%) reported problems with color discrimination. Using the National Eye Institute 25-Item Visual Function Questionnaire scores, we found that most patients reported improved vision and quality of life, but questions regarding general health, near activities, driving, and color vision remain to be addressed.
... The degree of mental stress most likely contributes to the degree of pain reported by patients. It is also likely that patients often have more mental stress before their first cataract surgery [18]. Additionally, the eye with a higher cataract grade is normally operated on first, so patients can have higher expectations of success from the first procedure. ...
Article
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Purpose. To evaluate and compare the subjective sensations reported by patients during first and second cataract extractions. Methods. Consecutive patients undergoing bilateral sequential cataract extraction using phacoemulsification were recruited. Following cataract surgery, patients completed questionnaires designed to evaluate subjective sensations, including anxiety, eye bulges, pain, and light sensitivity. Changes in painful sensations experienced by patients between the two surgeries were also recorded. Comparisons were also performed for each subjective sensation between different age groups (79 years). Results. A total of 127 patients were included in the final evaluation. Statistical comparison of the results showed that there were significant differences in perception of anxiety, eye bulges, and pain scores between the first and second cataract surgeries ( P < 0.05 ). However, there was no statistically significant difference for light sensitivity scores between the two surgeries ( P = 0.555 ). The differences in anxiety, perception of eye bulges, pain, and light sensitivity scores between both the surgeries showed no correlation with age ( P > 0.05 for all). Conclusions. Our research confirms the common observation that patients with bilateral cataracts often report more ocular discomfort during the second surgery. There are, therefore, additional factors that should be considered upon treating patients with bilateral cataracts, and the provision of preoperative counseling could play an important role in providing adequate patient care.
... The current literature and anecdotal clinical evidence indicated that the regional eye block, when used without sedation for anterior segment surgery (such as cataract removal or glaucoma surgery), could be a painful intervention (Van den Berg 2005, Ghali & Hafez 2010). Nijkamp et al. (2002) studied the fears of patients undergoing cataract surgery and identified that patients were afraid of REB anaesthesia, a fear often based on their past experiences. While some studies have reported that REB was well tolerated, their findings were often based on quantitative evidence (Costen et al. 2005, Bhatt et al. 2010. ...
Article
The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled. The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.
Article
Purpose To compare patient's comfort score, pain perception score as perceived by the patient; and patient's anxiety score, cooperation score assessed by the operating surgeon; and duration of surgery of the second eye phacoemulsification under augmented topical anaesthesia with the first eye surgery performed using the same technique, before. Secondary objectives were to find out if these parameters are associated with patient's age, gender, education, or occupation and the time gap between the two-eye surgeries. Settings and Design Prospective, cross-sectional observational study conducted in a tertiary care hospital for three months duration. Methods and Material 82 patients with visually significant cataract were included in the study. Group A ( n = 45) patients underwent phacoemulsification under augmented topical anaesthesia of the first eye and Group B ( n = 37) underwent phacoemulsification of the second eye, who had already undergone the first eye surgery using the same technique. Results Mean patient's comfort score 4.595 ± 0.4977, cooperation score 4.784 ± 0.4173, and duration of surgery 10.892 ± 1.2424 were higher in group B; whereas pain perception score 0.756 ± 0.7733 and patient's anxiety score 0.378 ± 0.5756 were higher in group A when the groups were compared. Conclusions There were no statistically significant differences in patients' comfort, pain perception score, patient's anxiety, cooperation score, and duration of surgery of the first and the second eye phacoemulsification under augmented topical anaesthesia. These scores were not significantly associated with age, gender, education, occupation, or the time gap between the first and the second eye surgeries.
Article
Purpose This study was conducted to evaluate the impact of precataract surgery fear levels on postoperative patient comfort. Design A descriptive study was conducted with 236 patients undergoing cataract surgery. Methods Study data were collected using the Introductory Information Form, Surgical Fear Scale, and Short General Comfort Questionnaire. The extent of the relationship between predictors affecting patient comfort in cataract surgery was evaluated using linear regression analysis. Findings A statistically significant negative correlation was found between preoperative fear and postoperative patient comfort. Surgical Fear Scale sub-dimensions, patients' inadequate information perception, gender, and previous cataract surgery experience were identified as predictors of comfort level. Conclusions Patients' surgical fear and being inadequately informed decreased postoperative patient comfort. Patient characteristics of male gender and prior cataract surgery were associated with increased postoperative comfort levels. This study revealed the importance of fear management and individualized care in cataract surgery.
Article
The expanding scope of physiotherapists has come with an increased level of responsibility to identify ‘red flag’ signs and symptoms. Red flags can indicate the presence of serious pathology but are notoriously unreliable. This leaves diagnosis heavily reliant on diagnostic investigations which are generally a finite resource within healthcare organisations. The COVID pandemic seems to have further compounded the problem and the possibility of ‘missed’ or ‘delayed’ diagnosis is ever-present. This may present a threat to patients’ lives, to clinicians’ careers and wellbeing, and to organisations’ finances and reputations. Although clinical risk in musculoskeletal physiotherapy may never be eliminated, there are opportunities to work towards minimising it. This professional issue will explore the complex problem of identifying serious pathology in musculoskeletal care and will propose strategies to manage the associated risks during the COVID pandemic and beyond.
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Belemmeringen voor zelfmanagementzelfmanagementzelfmanagementbelemmeringen waar de patiënt tegenaan loopt, hebben te maken met de informatievoorzieninginformatievoorziening en de communicatie tussen de professional en de patiëntcommunicatie professional en patiënt. Factoren die meespelen, zijn het uitwisselen van informatie, participatie, het nemen van beslissingen en het omgaan met de negatieve kanten van gezondheidsadviezen. Belemmeringen in de communicatie tussen professional en patiënt zijn instrumenteel versus affectief gedrag, (non-)verbaal gedrag, privacy, taalgebruik en de mate van ervaren controle. Barrières en kansen voor het bevorderen van zelfmanagement en shared decision-making worden beschreven vanuit het perspectief van professionals. Kansen zijn betere patient outcomes en dat het behandelproces voorspoediger verloopt, naast dat de professional zelf gemotiveerd is. De training Gezondheidscoach biedt paramedici concrete handvatten om het zelfmanagement en symptoommanagement van de patiënt te hanteren en beter om te gaan met shared decision-making.
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Objectives Ocular surgery is a source of significant concern for many patients, especially in high-stakes circumstances. The purpose of this study was to explore patient experiences of undergoing surgery on their only-seeing eye. Design A qualitative investigation using semistructured face-to-face interviews. Transcripts were analysed using thematic analysis. Setting Hospital eye service in the UK. Participants Twelve participants with a diagnosis of glaucoma with worse eye visual acuity <3/60± end-stage visual field loss. All participants had experience of undergoing surgery on their better-seeing (ie, ‘only’) eye. Results Data were coded into three key themes relating to (1) emotional impact of surgery, (2) burden of visual loss and (3) coping with surgery. Patients reported depressive symptoms at all stages of their surgical journey; concern about poor visual outcomes was a common feature. Only eye surgery imposes an emotional burden due to the uncertainty regarding individuals’ ability to continue daily activities and maintaining social roles. Burden extended to the inconvenience of frequent hospital visits and difficulties with follow-up care. Participants’ ability to cope effectively with surgery appeared to be linked to extent of support from healthcare professionals. Key areas in developing trust and support were an open and transparent dialogue between surgeons and patients, continuity of care, patient inclusion in decision-making, and observable empathy. Conclusions The findings indicate a need for an enhanced model of care in only eye surgery to better target patient preferences and allay concerns inherent with these procedures.
Article
Introduction: Residents learn technical and communication skills during training and practice both concurrently during awake surgical procedures. Patients have expressed mixed views on resident involvement in their surgical care, making this context challenging for residents to navigate. We sought to qualitatively explore resident perspectives on teaching during awake surgical procedures. Methods: Residents in Urology, Obstetrics and Gynecology, and General Surgery who had been exposed to 10 or more awake surgical procedures were recruited for recorded focus groups at the University of Chicago. Recordings were transcribed, coded, and reviewed by 3 researchers using the constant comparative method until thematic saturation was reached. Results: Twenty-five residents participated in 5 focus groups. Residents identified positive educational techniques during awake surgery including preprocedural communication, explaining teaching and the resident role, whispering/nonverbal communication, involving the patient in education, and confident educator. Residents described challenges and failures in education, including hesitating to ask questions, hesitating to correct a learner, whispering/nonverbal communication, and taking over. In discussing informed consent during awake procedures, some residents described that the consent process should or did change during awake procedures, for example, to include more information about the resident role. Conclusions: Residents participating in awake surgical procedures offer new insights on successful techniques for teaching during awake surgery, emphasizing that good communication in the procedure room starts beforehand. They also identify challenges with teaching in this context, often related to a lack of open and clear communication.
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Background: Cataract constitutes as the leading cause of blindness. Lack of information about the surgical procedure and results of surgery in cataract patients tend to show high levels of anxiety. Preoperative educational intervention planning is necessary to prepare patients for cataract surgery. The aim of present study was to identify emotional factors related to daily difficulties among patients having cataract.Methods: The present cross-sectional study was conducted over a period of 10months by means of a preformed pilot tested questionnaire on patients who had been screened for cataract in various eye camps and admitted for cataract surgery in the upgraded Department of Ophthalmology, Government Medical College, Jammu. All the questions were explained to participants in their local language for better understanding and those who were willing to participate, were requested to fill the semi-structure pilot tested questionnaire form with informed consent.Results: Around 75% of participants reported daily difficulties due to the ocular conditions, of which walking (79.6%) followed by doing housework (77.8%) were the most frequently reported difficulties. About 75% of the participants reported fearing the surgical procedure. Regarding the level of acceptance of cataract surgery 13.9% reported being very much afraid. With respect to the surgical procedure, doubt as to the outcome was reported by 22.2%. When cataract surgery was compared to other kinds of surgery, 31.9% thought it was better to undergo eye surgery whereas 48.6% had not given any opinion on the matter.Conclusions: Preoperative orientation is necessary in order to ease the suffering caused by surgery and render satisfaction with the treatment. Thus, patient should be prepared for the procedure, information regarding common outcomes and risks of surgery reduces anxiety and improves patient satisfaction following cataract surgery.
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Purpose Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries. Methodology/approach This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older. Findings First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers. Limitations Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type. Originality/value Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.
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Objectives The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. Methods In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. Results Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0–40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. Discussion Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.
Article
Importance Cataract-related vision impairment is an important public health issue that tends to affect older adults. Little is known about the association between older adults’ social support networks and their likelihood of receiving cataract surgery. Objective To determine if older adults with smaller social support networks are less likely to receive cataract surgery. Design, Setting, and Participants Retrospective cohort study. The National Health and Aging Trends Study, a nationally representative US survey, administered annually from 2011 to 2015 to a cohort of Medicare beneficiaries 65 years and older with no cataract surgery prior to the start of the study. Main Outcomes and Measures Multivariable logistic regression was performed to evaluate if the number of persons in an individual’s social support network influenced whether that individual received cataract surgery during a given year of the study. Results Overall, 3448 participants were interviewed from 2011 to 2015 for a total of 9760 observations. Of these observations, 3084 (weighted, 38.81%; 95% CI, 37.28-40.35) were aged 70 to 74 years, 5211 (weighted, 52.32%; 95% CI, 50.19-54.44) were women; 5899 (weighted, 78.53%; 95% CI, 76.29-80.61) were white, 2249 (weighted, 9.55%; 95% CI, 8.45-10.78) were black, 537 (weighted, 7.18%; 95% CI, 5.88-8.73) were Hispanic, and 303 (weighted, 4.74%; 95% CI, 3.56-62.9) reported other races. Medicare beneficiaries with smaller social support networks (0-2 individuals) were less likely to receive cataract surgery in a given year (adjusted odds ratio, 0.60; 95% CI, 0.37-0.96) than those with larger support networks (≥3 individuals). The adjusted predicted proportion of Medicare beneficiaries undergoing cataract surgery was 4.7% (95% CI, 2.7%-6.7%) and 7.5% (95% CI, 6.9%-8.1%) for those with small and large social support networks, respectively. Having fewer non–spouse/partner family members in the support network was associated with decreased odds of receiving cataract surgery (adjusted odds ratio, 0.60; 95% CI, 0.43-0.85), but having spouses/partners (adjusted odds ratio, 0.97; 95% CI, 0.77-1.22) and nonfamily members (adjusted odds ratio, 0.90; 95% CI, 0.72-1.11) did not have a significant association. Conclusions and Relevance Medicare beneficiaries with fewer non–spouse/partner family members in their social support networks were less likely to receive cataract surgery. These findings suggest that attention should be given to patients with smaller support networks to ensure that they receive cataract surgery when it is indicated.
Chapter
Patient education is more effective by tailoring, individualization, feedback and reward, facilitation, and participation (Sect. 5.1).
Article
Background: Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature. Methods: Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached. Results: Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned. Conclusions: Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient.
Article
Subjective visual perceptions experienced by patients during cataract surgery under local anesthesia have been given more and more attention now. Intraoperative visual experiences, including non-light perception, light perception, one or more color sensation, flash, movement, instrument, hands or fingers of surgeon etc., are complained in parts of patients. These sensations and experience often lead to a fear of patient. Being aware of these intraoperative sensations of fear from patient is necessary for us to take the preventing strategy in advance. In addition, counseling of these patients prior to surgery may alleviate fears and improve the satisfaction of patient with surgery outcome. This paper reviewed the current studies on this phenomenon, discussed its clinical implications and possible mechanism, and suggested novel approaches to reduce its negative impact on the surgery.
Article
Aim This paper aims to explore the role of pre-procedural education on the anxiety and/or pain levels of macular degeneration patients during intravitreal injections. Background The significance of pre-procedural education has been debated for many years, with many authors/clinicians alleging that informative preparation reduces pre-surgery anxiety levels and peri/post-procedural pain levels experienced by patients. Methods A comprehensive methodological analysis was employed in order to critically evaluate relevant research. A range of electronic databases and ancestry resources were searched for current contemporary articles published between January 2000 and March 2010. Search terms incorporating ‘anxiety’ ‘education’ ‘fear’ ‘discomfort’ ‘pain’ ‘ranibizumab’ and ‘macular degeneration’ were combined. The types of methodological studies were not specified in the strategy in order to prevent elimination of potentially applicable literature, therefore, both anecdotal and empirical articles were considered pertinent. Results Seven articles met the identified inclusion/exclusion criteria. Data abstraction was undertaken and all eligible studies were evaluated for quality, validity and reliability. Collectively, each of the studies reviewed placed emphasis on the importance on pre-procedural patient education and counselling. Nevertheless, individual differences exist in the amount, type and specificity of information provision provided. In general, the research articles reviewed also demonstrate the assumed existence of high anxiety levels pre-ophthalmic surgery commonly relating to patient anticipation and apprehension. Conclusion Greater understanding of the context within which educational provision impacts on patient anxiety and/or pain levels during intravitreal injections will facilitate the design of effective education and support systems for macular degeneration patients throughout the disease process.
Article
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The process of development of a Dutch smoking prevention project is described. An essential feature of the project is the combination and interaction of qualitative and quantitative research methods. It is advocated that each method has its own contribution and can be considered as a separate methodology contributing to social science in general and health education research in particular. Combining the two approaches in a spiral approach will result in a synergistic effect, because of the interaction of both approaches. The results of both methods suggest that qualitative methods enhanced the generation of ideas and theories. Qualitative methods were used to formulate ideas for improving quantitative data gathering, analyzing and comparing ideas with respect to program development, and for testing the internal validity of a quantitative design. The quantitative method enabled testing of results in different groups and detecting detailed differences. It also provided information that one of the assumptions of the program, the development of a teacher independent program, was not completely realized. The major advantage of using both methods is that this provides feedback between assumptions and data, thus enhancing comparison of results and critical reflection during the whole project.
Article
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Music has long been known to reduce anxiety, minimize the need for sedatives, and make patients feel more at ease. The purpose of the study was to evaluate the effect of music in elderly outpatients undergoing elective cataract surgery with retrobulbar block and monitored anaesthetic care using fentanyl or alfentanil and midazolam. One hundred and twenty one patients were prospectively and randomly assigned to hear: relaxing suggestions, white noise, operating room noise or relaxing music via audio-cassette headphones. Vital signs were documented before and after retrobulbar block and every 15 min thereafter. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after surgery. Visual analogue scales (VAS) were used to assess anxiety and patient satisfaction postoperatively with a standardized questionnaire. Between group comparisons were made using Chi-Square, or ANOVA, where appropriate. There were no differences between groups in STAI or anxiety VAS scores at any time. Differences were noted in systolic blood pressure, but not in other vital signs. Patients' ratings of the whole operative experience, satisfaction with the tape played, general level of relaxation and preference for the chosen tape for subsequent surgery were different (music > relaxing suggestions > white noise and OR noise, P < 0.05). Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied with their experience if they heard relaxing music, rather than relaxing suggestions or white noise or OR noise. The type of auditory stimuli to which the patients were exposed did not influence the level of anxiety.
Article
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Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.
Article
The connection between psychic and somatic symptoms with vision was investigated by studying 100 cataract operation patients, aged 71 to 76 years, 25 of them being men and 75 women. The investigations were conducted one day before the operation and three months afterwards. The cataract operation restored sufficient acuity of vision for reading (minimum E-test value 0.40) to 79% of the old people. Psychic vsymptoms were tested with the Brief Psychiatric Rating Scale, Mini-Mult MMPI, and direct questions. Somatic symptoms were studied through questionnaires. Psychic symptoms showed a statistically significant correlation with vision before the cataract operation but not afterwards. Psychic symptoms increased with deterioration of the acuity of vision and diminished when the acuity of vision improved. Somatic symptoms did not show similar association with vision but the symptoms were significantly alleviated after the cataract operation. Restoration of vision through the cataract operation normalized the old people's psychic condition and reduced their somatic symptoms to correspond with their prior chronic diseases.
Article
Self-reports of fear from 100 patients (25 men and 75 women 71 to 76 years old) having two cataract operations were investigated. 33% of the patients reported having fear and 32% felt tension about the operation performed on the first eye. Women feared the operation significantly more than men. Fears were significantly associated with hypochondriasis, hysteria, and hypomania (unadjusted) as indicated by correlations with scores on the Mini-Mult MMPI. The cataract operation restored sufficient visual acuity for reading (minimum E-test value 0.40 or 1.8-cm high letters at a distance of 6 meters) to 79% of the subjects. The experience of a good operation result on the first eye significantly reduced the fear of the cataract operation on the second eye and at the same time the fear of becoming blind. Other factors reducing fear included positive experiences of a safe and painless cataract operation.
Article
A review of clinical, experimental, and field research on stress, together with the author's own research, provides the background for a theory that emphasizes the importance of cognitive processes. Harvard Book List (edited) 1971 #370 (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Examined 1,200 letters written by cataract sufferers (median age 70 yrs) or their relatives in response to a brief article about cataracts in a popular magazine in order to study the relation between cataracts and emotions. Results show that most Ss had extreme fear of loss of enjoyment and self-sufficiency. There was concern that the operation would fail and they would be left blind. Many Ss were concerned that they were too old to receive the operation. It is suggested that the fears are based on misperceptions and that improved public information about the safety of the operation could reduce those fears. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Fifty-five men undergoing cardiac bypass surgery completed the state measure of Spielberger's State-Trait Anxiety Inventory (STAI-S) and an anxiety-investigating personal questionnaire (PQ) using the Shapiro method. Of the 55 men tested at baseline, 29 were seen immediately before surgery and 51 post-operatively; 48 were followed-up 8 weeks later. PQs were not more sensitive to anxiety than the STAIS; when made comparable, both were similar in their sensitivity to anxiety. The psychometric properties of the PQ and the STAI-S were very similar. PQ reliability was negatively correlated with lower verbal ability and higher trait anxiety, suggesting these characteristics affect PQ responses. PQ techniques are psychometrically rigorous, but provide no advantage in measurement. Concurrent personality assessment at the first and final test sessions using the revised, abridged Eysenck Personality Questionnaire (EPQR-A) found all four subscales of the measure highly reliable over time (minimum test-retest r = 0.59); the only subscale to show a significant change was a slight reduction in self-reported Psychoticism at follow-up. Despite a significant reduction in state anxiety after life-transforming, radically health-improving cardiac bypass surgery, the major traits of personality remained essentially stable.
Article
The connection between psychic and somatic symptoms with vision was investigated by studying 100 cataract operation patients, aged 71 to 76 years, 25 of them being men and 75 women. The investigations were conducted one day before the operation and three months afterwards. The cataract operation restored sufficient acuity of vision for reading (minimum E-test value 0.40) to 79% of the old people. Psychic symptoms were tested with the Brief Psychiatric Rating Scale, Mini-Mult MMPI, and direct questions. Somatic symptoms were studied through questionnaires. Psychic symptoms showed a statistically significant correlation with vision before the cataract operation but not afterwards. Psychic symptoms increased with deterioration of the acuity of vision and diminished when the acuity of vision improved. Somatic symptoms did not show similar association with vision but the symptoms were significantly alleviated after the cataract operation. Restoration of vision through the cataract operation normalized the old people's psychic condition and reduced their somatic symptoms to correspond with their prior chronic diseases.
Article
Adult patients in a family medicine clinic were surveyed to identify variables related to situational anxiety in a relatively unthreatening medical setting. Anxiety scores ranged from extremely calm to extremely anxious, with the average near the midpoint. Scores on other variables were reliably related to degree of reported anxiety. Multiple regression and discriminant analyses revealed the following to be the strongest predictors of higher anxiety: a passive orientation toward the visit; uncertainty about the state of one's health; expectations of physical discomfort, embarrassment, and invasion of privacy; a shorter time waiting; and few previous exposures to the clinic, physician, and procedure. Results are discussed in terms of implications for practice and for future research.
Article
One day after surgery for senile cataract, we interviewed 50 patients to determine what percentage of the preoperative informed consent was retained. No patient felt less inclined to undergo surgery after hearing the informed consent and all patients believed the preoperative explanation had been adequate. This study found retention of relevant information was only 37% when assessed by ten standard questions. Only two (4%) of the patients remembered more than two of the five risks of surgery. Blindness, the most frequently recalled, was known by only 17 (34%). More than 80% failed to recall either hemorrhage (46/50), infection (47/50), failure of the procedure to improve visual acuity (42/50), or death (44/50) as other complications. Only 20% (10/50) would have remembered to protect the operated-on eye. Patients denied prior counseling for four of the ten questions (mean). Factors related to poor retention include advanced age and less than a high school education. Previous cataract surgery, level of anxiety prior to surgery, and the patient's sex did not appear to influence retention.
Article
Although ophthalmologists have long recognized that visual acuity alone is an inadequate measure of visual impairment, the need for and outcomes of cataract surgery historically have been assessed in terms of visual acuity. To examine the relation among different cataract surgery outcome measures, including a 14-item instrument designed to measure functional impairment caused by cataract (the VF-14), at 4 months after cataract surgery. The authors performed a longitudinal study of 552 patients undergoing first eye cataract surgery by 1 of 75 ophthalmologists practicing in Columbus, Ohio, St. Louis, Missouri, or Houston, Texas. Patients were interviewed, and clinical data were obtained preoperatively (July 15, 1991-March 14, 1992) and 4 months postoperatively. The percentage of patients judged to be improved at 4 months after cataract surgery varied by the outcome measure used: Snellen visual acuity (96%); VF-14 score (89%); satisfaction with vision (85%); self-reported trouble with vision (80%); and Sickness Impact Profile score (67%). The change in patients' ratings of their trouble with vision and their satisfaction with vision were correlated more strongly with the change in VF-14 score than with the change in visual acuity (operated eye or better eye). The average change in VF-14 score was unrelated to the preoperative visual acuity in the eye undergoing surgery. Estimates of the proportion of patients benefiting from cataract surgery vary with the outcome measure used to measure benefit. Change in VF-14 score, a measure of functional impairment related to vision, may be a better measure of the benefit of cataract surgery than change in visual acuity.
Article
To better define the effectiveness and risks of modern cataract surgery. Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n = 17,390 eyes) or complications (n = 68,316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phaco-emulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications. The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution. The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.
Article
Self-reports of fear from 100 patients (25 men and 75 women 71 to 76 years old) having two cataract operations were investigated. 33% of the patients reported having fear and 32% felt tension about the operation performed on the first eye. Women feared the operation significantly more than men. Fears were significantly associated with hypochondriasis, hysteria, and hypomania (unadjusted) as indicated by correlations with scores on the Mini-Mult MMPI. The cataract operation restored sufficient visual acuity for reading (minimum E-test value 0.40 or 1.8-cm high letters at a distance of 6 meters) to 79% of the subjects. The experience of a good operation result on the first eye significantly reduced the fear of the cataract operation on the second eye and at the same time the fear of becoming blind. Other factors reducing fear included positive experiences of a safe and painless cataract operation.
Article
To investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation using retrobulbar anesthesia. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Seventy cataract patients who had routine phacoemulsification and posterior chamber IOL implantation under retrobulbar anesthesia were interviewed on the day of their surgery regarding their visual experience in the operated eye during surgery. Thirty-nine men (55.7%) and 31 women (44.3%) were included in the study. Their mean age was 65.1 years (range 37 to 87 years). Preoperative best corrected visual acuity ranged from 6/12 to counting fingers. Sixty eyes (85.7%) had no ocular pathology other than cataract. Eleven patients (15.7%) reported no light perception during the surgery. The rest reported they could see light (59 patients, 84.3%), 1 or more colors (39 patients, 55.7%), flashes (35 patients, 50.0%), movements (34 patients, 48.6%), instruments (12 patients, 17.1%), and the surgeon's fingers or hands (11 patients, 15.7%). The colors seen included red (23 patients, 32.9%), blue (17 patients, 24.3%), yellow (12 patients, 17.1%), green (7 patients, 10. 0%), and orange (1 patient, 1.4%). Eight patients (11.4%) saw a spectrum of colors similar to a rainbow. Thirty-one patients (44.3%) reported that the brightness of light changed during surgery. Five patients (7.1%) found their visual experience frightening. Patients who reported seeing colors (P =.048, Fisher exact test) and flashes of light (P =.027, Fisher exact test) were more likely to find the experience frightening. There was no statistically significant correlation between those who found the experience frightening and patient sex or age, length of surgery, or history of cataract surgery in the fellow eye. Many patients having phacoemulsification and IOL implantation under retrobulbar anesthesia experienced a variety of visual sensations that were frightening in a small proportion of cases.
Article
To analyze the determinants of satisfaction and postoperative visual function after cataract surgery in 3 settings in The Netherlands. University Hospital Maastricht (outpatient care), Atrium Medical Center Heerlen (inpatient care), and Medical Center Maastricht Annadal (outpatient care), Maastricht, The Netherlands. This cross-sectional study consisted of 150 patients of 50 years and older who had first-eye phacoemulsification with intraocular lens implantation. Data were collected by a written questionnaire. The following parameters were measured: medical outcome, postoperative function, patient satisfaction with medical outcome and hospital care, and overall patient satisfaction. In general, patients were very satisfied (mean score 8.43 on a 10-point scale ranging from 1 = very bad to 10 = excellent). The 3 centers did not differ regarding the patient satisfaction (P =.092). However, postoperative visual function (P =.012), counseling (P =.010), and waiting time (P <.001) were different among the settings. Patient satisfaction with hospital care had a stronger correlation with overall satisfaction than patient satisfaction with the medical outcome (r = 0.669 versus r = 0.543, respectively). A causal model of patient satisfaction was tested, indicating that satisfaction was related to the patient's preoperative expectations and the quality of care given during the hospital stay and follow-up at the outpatient clinic. This emphasizes the relevance of patient education (to set realistic expectations) and counseling (need for care) by hospital staff in a cataract surgery setting.
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